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Site Address: 5828 Fairlane Rd, Acampo CA 95220 Record ID: WP0041895 <br /> Date: 4/8/2021 <br /> PHOTO #2 New Well. Grouted with 10.3 sand cement from 100f ft. <br /> KNIF"WOU RESOURCES COUPANY .•... „.. TKTN J.. .. DATE: 04/08/11 <br /> Rilling OFFICE (S209oC 93306960 REQUESTED OELIVFRY TIM F: 11:00 <br /> www.kniferiver.com ORDER NUMBER: 55026 <br /> SQ et StI Dispatch: (800) 464-6572 ! (209) 933-6999 TICKET NUMBER: 1066487 <br /> TRU6616 /�►•�►' ---_°•�• BOX 66001, Stockton, CA 95205 CYD5 DEL: 5,00 <br /> DRIVER PLANTIO' LEAVEPLANT -ARRIVEIOB' STARTPOUR END POUR LOLEAVEJ08 AT PLANT <br /> 55034182 HFTURO SAt�^OVAi STCCf:` D'o2 S <br /> CUSTOMER ACCT ID CUSTOMER P,O <br /> ./PROTECT NO. <br /> 378044 PROJECT NAME LOT&BLOCK <br /> / <br /> SOLD TO: PREVIOUS TRUCK <br /> VALLEY DRILLING DELIVERY ADDRESSAOCATION: ADDRE55VERIFIED? Check <br /> VALLEY DRILLING;5828 FAIRLANE R <br /> ACAMPO <br /> ADDITIONAL DELIVERY INSTRUCTIONS: _ <br /> W/T DRUM REVOLUTIONS <br /> 1 t thlstoad ,Qty Ordered - -- ---_ <br /> BEGINNING ENDING I 10-,qQty Divd Product Code ----- <br /> 5.00 J p - - Product Description UOM Unit Price _ EXT Am.- <br /> ADDED/ESTIMATED SLUMP <br /> STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL 912.50 <br /> pad: GAL SLUMP Excess truck time will be assessed: dispatch at the current SALES TAX $70.72 <br /> 2/3 Load. GAL SLUMP rate per minute for orders exceeding five(5)minutes Per ADDITIONAL TIME FEE I TICKET TOTAL $993.22 <br /> 1/3 Load: GAL SLUMP cubic yard. <br /> DESIGN SLUMP REQUESTED SLUMPGRAND TOTAL $983.22 <br /> 0.00 8.00 <br /> ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE <br /> USE OF CONCRETE,AS PLACED: Signature: 6-,y� o Printed Name: <br /> RELEASE:Contractor or Owners agree to indemnify and saveLharmless Knife River Corporation from Ilablllty Imposed as a <br /> result of any damage caused to the property of others as a result of such delivery.FOR ADDITIONAL RELEASE <br /> INFORMATION:SEE WWW.KNIFERIVER.COIVI/NCA FOR PROP 65 INFO WWW.P65WARNINGS.CA,GOV <br /> TESTED BY AIR/SLUMP/TEMP/CYL'S <br /> ISignature: Printed Name', <br /> Knife River Weighmaster Certificate <br /> THIS IS TO CERTIFY that the following described commodity was weighed, measured or counted by a weighreaster, <br /> whose signature is on the certificate, who is a recognized authority of accuracy, as prescribed by Chapter T <br /> (commencing with section 12700) of Division 5 of the California Business and Professional Code, administered by <br /> the Division of Measurement Standards of the California Department of Food and AgrlCulture. <br /> Deputy <br /> Truck Driver User Disp Ticket Num Ticket ID Time Date <br /> 550341822 622078 user 1066487 95685 10:16 4/8/21 <br /> Load Size Mix Code Returned Qty Mix Age Seq Load ID <br /> 5.00 CYD.E 504 D 21 <br /> Matenal Design oty Required Belched %Var%Moisture Actual Wal Tdm <br /> TYPEII-V 968.0 Ib 4840.0 Ib 4830.0 Ib -021% <br /> 'SAND 1936 Ib 10172 Ib 10240 lb 0.88% 5.09geA 496 Its <br /> 1502 lb -25.00 p1 <br /> CRY 609 Ib 1509 ib 1502 lb -o A6% <br /> Actual Num Belches 1 <br /> Francisco Garcia Ruiz, Environmental Health Asst Page 2 of 3 <br />